Campaigners and clinicians are calling for sweeping reform of NHS maternity services following the publication of two major reports into patient safety, as the government prepares to launch a national taskforce to overhaul care.
The reports, led respectively by Baroness Valerie Amos and midwifery expert Donna Ockenden, examined systemic failures in maternity care across England, including cases of preventable baby loss, injury and maternal death. Health and social care secretary Yvette Cooper has said she wants to "put the cradle back at the heart of the NHS" and has committed to appointing a national maternity commissioner, according to comments she gave to the Guardian last week.
Julia Sanders, professor of clinical midwifery at Cardiff University and an expert adviser to the Amos-led national maternity and neonatal investigation, said families affected by poor maternity outcomes have long campaigned for accountability, but that previous reviews have failed to deliver resolution. She argued that only "radical whole-system change" — the phrase used in the Amos inquiry's own conclusions — would be sufficient to address the problems identified.
The Ockenden review examined more than 700 maternity cases with poor outcomes, including stillbirth, severe perineal trauma and major haemorrhage, drawn from over 41,000 births recorded between 2020 and May 2025. In more than 80% of those cases, the review found that care had been in line with best practice, or that a different approach to management would not have changed the outcome.
Sanders said this distinction was important, noting that poor outcomes do not necessarily equate to poor care. She pointed to regular national surveys conducted by Oxford University, which have reported consistently high rates of overall satisfaction with maternity care between 2006 and 2024.
Separately, research from the Neonatal Data Analysis Unit at Imperial College London found that the number of babies born at term with brain injury caused by oxygen deprivation declined between 2015 and 2021, alongside falling stillbirth rates. However, figures from the National Perinatal Epidemiology Unit at Oxford University show that the overall maternal death rate in the UK during 2022 to 2024 was 20% higher than in 2009 to 2011.
The Amos inquiry also identified persistent inequalities in maternity care, including reports of overt racism, alongside continuing accounts of physical and psychological trauma among women using the service.
Workforce pressures were highlighted as a significant contributing factor. The Amos inquiry found that only 22% of midwives reported having sufficient time to do their job well. A Guardian report last month also documented rising numbers of midwives leaving the profession, citing burnout as a key driver.
Sanders said midwives are frequently blamed in media coverage of maternity failures, but that this "undermining and villainising" does not serve women, families or the service. She said midwives are the only professional group working with women, babies and families across the entire maternity journey, in both hospital and community settings, and that other services depend on the platform they provide.
The report also raised concerns about the unintended consequences of piecemeal safety initiatives. NHS data cited in the reports shows that rates of labour induction rose from around 20% before 2010 to more than 34% by 2020, before falling slightly. Caesarean section rates increased from 27% of births in 2016 to 45% by 2025 — equivalent to roughly 100,000 additional caesarean births each year compared with a decade earlier.
Sanders warned that a narrow focus on clinical interventions as the primary route to improving safety risks displacing resources and overlooking core elements of maternity care. She said some women need to be "held safely through loss," and that all women require skilled care, clear information and trusting relationships with their maternity team. Continuity of midwifery care built around ongoing relationships has been shown to produce positive outcomes, she said, yet few women currently receive this model of care.
The national maternity and neonatal taskforce, which Cooper is set to chair, has been tasked with delivering the recommendations set out in both the Ockenden review and the Amos inquiry. Sanders said the taskforce must be prepared to redefine what NHS maternity services can and should provide, and to negotiate for the resources required to deliver that vision.
She called for two central shifts to underpin any reform. First, a reset of the relationship between maternity services and the women and families who use them, giving both patients and frontline staff genuine influence over how services are designed, delivered and monitored. Second, she said decisions on the future shape of maternity care must be guided by evidence on clinical effectiveness, cost-effectiveness, women's experiences and what can realistically be implemented and sustained across the system.
Sanders said sustained commitment and accountability would be needed from politicians, NHS boards, regulators, professional leaders, educators and every member of the multidisciplinary maternity team if the taskforce's work is to succeed. She said the future health and wellbeing of the population depended on this level of reform being delivered.
